改良马利兰-环磷酰胺2预处理方案在异基因造血干细胞移植中的应用

目的探讨改良马利兰-环磷酰胺2(Bu-CTX2)预处理方案在异基因造血干细胞移植(allo-HSCT)治疗恶性血液病的疗效。方法采用阿糖胞苷(Ara-c)、Bu或白消安针剂(白舒非)、CTX、甲基环己亚硝脲(Me-CCNU)及抗胸腺细胞球蛋白(ATG)联合作为改良Bu-CTX2预处理方案行allo-HSCT治疗恶性血液病15例。结果全部患者均顺利植入干细胞,白细胞>1.0×109/L的中位时间16.3天(+12～+20天),血小板>20×109/L的中位时间28.3天(+20～+51天);15例患者中出现全身急性移植物抗宿主病(aGVHD)Ⅳ度1例,aGVHDⅡ度2例,无Ⅲ度aGVHD发生,aGVHDⅡ～Ⅳ度的发生率20.0%,Ⅲ～Ⅳ度的发生率6.7%,随访中位时间为30.7(4～65)个月;无预处理相关死亡,无复发。结论采用改良Bu-CTX2预处理方案行allo-HSCT治疗恶性血液病是安全有效的方法 。

Application of modified Bu-CTX2 preconditioning in allogenic hematopoietic stem cell transplantation

Objective To study the effect of the modified Bu-CTX2 preconditioning in allogenic hematopoietic stem cell transplantation.Methods We used the modified Bu-CTX2 preconditioning made up of cytosine arabinoside（Ara-c）,busulphan（Bu）,cyclophosphamide（CTX） and methyl CCUN（Me-CCNU） for 15 cases who underwent haploidentical hematopoietic stem cell transplantation.Results Fifteen cases achieved complete engraftment.The median time of the neutrophil recovery 〉1.0×10^9/L was 16.3（12-20） days after transplantation.The median time of the platelet recovery〉20×10^9/L was 28.3（20-51） days after transplantation.One case developed grade Ⅳ acute graft versus host diseases（aGVHD）.Two cases developed grade Ⅱ acute graft versus host diseases.No case developed grade Ⅲ acute graft versus host disease.The overall incidence of Ⅱ-Ⅳ aGVHD was 20.0%.The incidence of Ⅲ-Ⅳ aGVHD was 6.7%,all patients survived disease-free with a median follow-up of 30.7（4-65） months.Conclusion Allogenic hematopoietic stem cell transplantation with the modified Bu-CTX2 preconditioning is safe and effective.